Advanced Biomedical Engineering DOI:10.14326/abe.12.

81
12: 81–90, 2023. Original Paper

Development of an Electric Pegboard (e-Peg) for Hand Dexterity Improvement and Cognitive
Rehabilitation: A Preliminary Study

Sayaka OKAHASHI,*, **, ***, # Kenta SAKAMOTO,†, †† Fumitaka HASHIYA,††† Keisuke KUMASAKA,‡
Taro YAMAGUCHI,‡‡ Akitoshi SEIYAMA,**, *** Jun UTSUMI‡‡

Abstract Fine motor dysfunction and cognitive impairments commonly develop after stroke, which great-
ly impact the daily lives of patients. In current occupational therapy, hand dexterity and cognitive functions are
evaluated individually (e.g., by manipulation of small objects with fingers, or a paper-and-pencil test), which is
insufficient for therapists to grasp the total ability of combined dexterity and cognition in everyday situations.
Additionally, the traditional methods require a tester to measure the completion time manually and tend to be
monotonous for patients. These problems would be solved using technology. This study aimed to develop a new
electric pegboard (e-Peg) prototype and to investigate preliminary utility in healthy adults. The system judges
the peg insertion accuracy based on magnetism and records the time course and scores, which are linked to hu-
man object manipulation ability. The e-Peg executes three types of tasks: a basic color matching task (BT), a
color comparison task using a pattern sheet (CT), and a visual memory task (MT), with one/two-color sample
patterns. Six older and nine younger healthy adults performed the e-Peg tasks, functional tests, and responded
to questionnaires. As a result, the number of correct answers in a bicolor symmetrical MT were significantly
greater in the younger group than in the older group. The older group required a significantly longer comple-
tion time for BT and CT than the younger group. Significant correlations were found between one-color BT/
CT and dexterity tests, between bicolor BT/CT and dexterity/cognitive tests, and between a bicolor MT and a
cognitive test. Questionnaire results revealed that participants regarded BT/CT as easy/interesting tasks,
whereas MT was considered a difficult/challenging task. In conclusion, our e-Peg is potentially a useful reha-
bilitation device that facilitates many tasks related to hand manipulation and attention/executive functions, and
a valuable tool for personalized therapy.

Keywords: electric pegboard, hand dexterity, cognitive functions, occupational therapy, digital rehabilitation
device.

Adv Biomed Eng. 12: pp. 81–90, 2023.

1. Introduction
Received on May 12, 2022; revised on October 21, 2022 and Jan- In the rapid aging society, the number of older patients
uary 23, 2023; accepted on January 24, 2023.
*
(≥ 65 years) continues to rise. The number of patients
Center for Gerontology and Social Science, National Center for
Geriatrics and Gerontology, Aichi, Japan.
with cerebrovascular disease who received treatment,
**
Department of Human Health Sciences, Graduate School of Med-
follow-up, or rehabilitation in Japan was approximately
icine, Kyoto University, Kyoto, Japan. 1.12 million in 2017, and more than 80% were older
***
Creative Design & Data Science Center, Akita International Uni- adults [1]. The average hospitalization time in the recov-
versity, Akita, Japan. ery phase rehabilitation ward is approximately 70–85
†
Healthtech Business Division, Techlico Inc., Osaka, Japan. days [2]. Motor and sensory dysfunctions as well as cog-
††
Department of Physical Medicine and Rehabilitation, Kansai nitive impairments such as inattention and memory dis-
Medical University, Osaka, Japan.
†††
Research Center for Material Science, Nagoya University, Aichi,
Japan.
Copyright: ©2023 The Author(s). This is an open
‡
Department of Rehabilitation, Asaka Hospital, Fukushima, Japan. access article distributed under the terms of the
‡‡
Medical Science and Business Liaison Organization, Graduate Creative Commons BY 4.0 International (Attribution) License (https://
School of Medicine, Kyoto University, Kyoto, Japan. creativecommons.org/licenses/by/4.0/legalcode), which permits the
#
7–430 Morioka-cho, Obu, Aichi 474–8511, Japan. unrestricted distribution, reproduction and use of the article provided
E-mail: okahashi@ncgg.go.jp the original source and authors are credited.
 (82) Advanced Biomedical Engineering. Vol. 12, 2023.

orders are common after stroke [3]. The symptoms great- and a prototype of an electronic version of the GPT [18]
ly impact patients activities of daily living (ADLs) as have been developed. These electronic pegboards auto-
well as other leisure, hobby and work activities. Occupa- mate precise time calculation, but they were based on
tional therapy (OT) is conducted in order to improve up- traditional pegboards and only focused on hand manipu-
per limb movement, hand dexterity, cognitive functions, lation assessments.
and ADL abilities in particular. Accordingly, the present study aimed to develop a
Conventionally, hand skills and cognitive functions novel electric pegboard (e-Peg) prototype and investigate
are evaluated separately using test batteries. A tester usu- its utility in healthy adults. This paper proposes a e-Peg
ally scores using a stopwatch manually. For instance, the system that facilitates three easy to moderate cognitive
Purdue Pegboard Test (PPT) [4, 5], Nine-Hole Peg Test level tasks, and reports the results of preliminary evalua-
(NHPT) [6], Grooved Pegboard Test (GPT) [7], O Con- tion experiments.
nor Finger Dexterity Test [8], and Box and Block Test
2. Materials and methods
(BBT) [9, 10] are used to examine fine manual dexterity.
These are time-based tests used to define performing 2.1 The e-Peg system
skills, and their reliability has been established in clinical 2.1.1 Experimental apparatus
patients. (such as NHPT for multiple sclerosis [11]; The e-Peg system comprises a main body that is 50 mm
NHPT and PPT for Parkinson s disease [12]). Trail Mak- high, 180 mm wide, and 200 mm deep, with 16 (4 × 4)
ing Tests (TMT) [13, 14], Digit Span [15], and Symbol hall sensor-incorporated holes on a top board that fit
Digit Modalities Test [16] are used to examine attention, pegs. The system weighs 650 g including accessories
working memory, and perceptual speed. These tests are consisting of 8 red and 8 blue color pegs (φ15 × 50 mm)
paper-and-pencil or oral tests that evaluate the number of with neodymium magnet (φ8 × 3 mm) at the bottom tip
correct answers and the time required to answer. of each peg. The tip of the red peg is N-pole, and that of
Currently, there are few clinical evaluation and exer- the blue peg is S-pole (Fig. 1a). There is also a liquid
cise methods that encompass a combination of motor crystal display (LCD) screen and 6 navigation buttons
and cognitive domains (for example, a PC typing task for lights and sounds located on the side of the system
that copies a sample text or an exercise task using a com- (Fig. 1b). An examiner conducts an e-Peg task by oper-
mercial game like Nintendo WiiTM) in OT, as these are ating these buttons while confirming messages displayed
often too difficult to perform for recovering patients with on the LCD screen.
slow rough movements and low attention function, be- Each hole is illuminated in red or blue color after
cause the existing tasks require moderate- to high-level reading the task pattern from a built-in SD memory card
upper limb and cognitive functions. programmed by an examiner in advance. When an exam-
These problems could be solved using technology. inee inserts the peg with the same color of the lit hole, the
Recently, some studies reported epochal digital devices. system judges this as correct based on magnetism. It also
A custom-made electronic pegboard test using an infra- emits two kinds of sounds, pee for a correct answer and
red sensor and microcontroller based on the NHPT [17] poo-poo-poo for an incorrect answer. A short melody is

Fig. 1 The e-Peg system.

(a) the main body with lights off and pegs; (b) the main body with lights on and illustrated navigation buttons.
 Sayaka OKAHASHI, et al: e-Peg Development for Dexterity/Cognitive Rehabilitation (83)

played upon each task completion and green lights are

also illuminated. The block diagram and software flow-
chart are shown in Fig. 2. The electrical circuit diagram
is shown in Supplementary Fig. 1.
Log data is recorded automatically in a comma sep-
arated value (CSV) format on the SD memory card (See
Supplementary Table 1). The parameters included the
peg holes operated, correct/incorrect determination, and
the elapsed time after task initiation. The e-Peg housing
and pegs were created with a 3D printer (Replicator +,
MakerBot Industries, LLC.) using ABS filament based
on a blueprint designed by HILLTOP Corporation (Kyo-
to, Japan).

2.1.2 Task setting

Three types of e-Peg tasks were created as follows:
●A basic task (BT): The examinee inserted a peg with
the same color as that of the hole lighting. Eight holes
remained lit in red or blue until the task was complet-
ed, and response sounds were produced to indicate the
match between the peg and hole (Fig. 3a).
●A comparison task (CT): The examinee inserted a peg
into a relevant hole based on the color and position on
a printed design sheet placed in front of the e-Peg sys-
tem. Sounds were produced during the task, although
the holes were not lit (Fig. 3b).
●A memory task (MT): The examinee memorized the
colors and positions of the lights on the main body by
observing it for 5 seconds, after which he/she inserted
the colored pegs into the matching holes. Response
sounds were produced during the task performance,
although the holes were not lit (Fig. 3c).
The examinees were required to manipulate the pegs
individually as quickly as possible for each task condi-
tion under the instruction of an occupational therapist. In
the case where a participant responded incorrectly and
took over 10 seconds to insert the next peg, the examiner
verbally explained that the participant could not provide
any more answers and then switched on the LED lights
to present the answers.

2.1.3 Sample patterns

Twelve e-Peg sample patterns were created. Six patterns
(Fig. 4, a–f) were selected for use in this study. Eight of
the sixteen holes were lit, giving a light ratio of 50%.
Two elements, light color and symmetry, were consid-
ered to set difficulty levels: pattern a was composed of a
one-color asymmetrical pattern; patterns b, c and d were
bicolor symmetrical patterns; and patterns e and f were
bicolor asymmetrical patterns.

2.2 Data collection

The preliminary evaluation experiments aimed to exam- Fig. 2 The e-Peg system design.
 (84) Advanced Biomedical Engineering. Vol. 12, 2023.

Fig. 4 Sample patterns.

The 6 patterns with bold borders were adopted in
this study, presented from an examinee s point of
Fig. 3 Three types of e-Peg tasks.
view.
Presented from an examinee s point of view.

ine the following: 1) comparison of e-Peg performance

by age group, 2) relationship between e-Peg scores and
functional assessment, and 3) subjective evaluation.

2.2.1 Participants
Six older and eleven younger healthy adults participated
in this study. Written informed consent was obtained
from all participants and the study was approved by the
Ethics Committee at Kyoto University Graduate School
and Faculty of Medicine (R2005-1). All participants Fig. 5 Scene of the experiment.
were right-handed. The inclusion criteria were as fol-
lows: people who 1) could operate the e-Peg while sit-
ting for more than 30 minutes; 2) could communicate board (SAKAI Medical Co., Ltd.) placed on the right
with the examiner in Japanese; 3) were generally inde- side of the main body (Fig. 5). The participants per-
pendent in their ADLs at home; 4) scored more than 24 formed the e-Peg task with the dominant right hand in
points on the Mini-Mental State Examination (MMSE); the following order: BT (using patterns a and b), CT (us-
and 5) did not have any serious disease (e.g., cerebral ing patterns a and c), and MT (using patterns b, d, e and
nerve system or orthopedic disease of the upper limbs f). The number of correct answers and completion time
with sequela). were used to calculate e-Peg score.
A five-point scale questionnaire was conducted after
2.2.2 The e-Peg test and a questionnaire the e-Peg tasks to evaluate subjective user-friendliness,
The participants sat in a chair with the soles of their feet interest level, and difficulty level of each task.
placed on the floor. They were seated at one-fist width
from the edge of a desk measuring 70 cm high, 159 cm 2.2.3 Upper limb/ cognitive function tests
wide, and 69 cm deep in a silent room. The height of the The grip and pinch strength were used to measure upper
desktop was adjusted based on the participants elbow limb muscle power; the BBT and PPT were used to eval-
positions when their arms were down and their elbows uate hand dexterity. Attention and executive function
were bent at 90 degrees. The e-Peg main body was placed were assessed by the TMT. MMSE was conducted for
in front of each participant. The eight red and eight blue older adults as a general cognitive screening.
pegs were set upright alternately on a wooden setting The BBT standardized by Mathiowetz et al. [9] in
 Sayaka OKAHASHI, et al: e-Peg Development for Dexterity/Cognitive Rehabilitation (85)

1985 is an elaborate test in which a person is required to reported below. The abbreviated task names and com-
move a maximum number of 25-mm cubic blocks from ments are shown in Table 2. The MT scores using two
one box to another within 60 seconds [9, 10]. The PPT patterns (pattern b which was a practice task and pattern
developed by Joseph in 1948 is a finger and upper limb f having plural empty values) were excluded from data
manipulability test [4] that requires a person to pick up analysis.
pins and fill in peg holes starting from the topmost hole;
the test may be executed using one hand or both hands 3.2 The e-Peg performance
within 30 seconds. The TMT requires participants to link Both age groups marked the full number of correct an-
numbers (1–25) in ascending order (in part A: TMT-A), swers in BT/CT, but the number of correct answers were
or numbers (1–13) and Hiragana characters ( a – shi ) significantly greater in the younger group than in the old-
alternately in ascending order (in part B: TMT-B) with a er group in a MT using a bicolor symmetrical pattern
single stroke of a pencil without error as quickly as pos- (Fig. 6a). The older group required a significantly longer
sible. This test assesses task transition and attention time to perform both BT and CT than the younger group
switching [13, 14]. (Fig. 6b).

2.3 Data analysis 3.3 Relationship between e-Peg score and dexterity/
Comparisons between the two groups were performed cognitive tests
using Wilcoxon s rank sum test for the demographic data There were significant negative correlations between
and the e-Peg scores. Spearman s correlation was per- one-color BT/CT and dexterity tests. There were signif-
formed to determine the association between e-Peg icant correlations between bicolor BT/CT and dexterity/
scores and dexterity or cognitive scores. Differences cognitive tests. A significant negative correlation be-
were reported significant if p < 0.05. Analyses were con- tween bicolor MT-1 and cognitive test (TMT-B) was also
ducted using JMP Pro 16.2 (SAS Institute Inc.).

3. Results
Table 2 Abbreviated task names and comments.
3.1 Demographic data
The results obtained from a total of 15 healthy adults (six Task name sample pattern used characteristic
older and nine younger) are reported as below. The data one-colored BT a symmetry
of two young adults were excluded due to equipment bicolored BT b asymmetry
failure. Dexterity (BBT, PPT) with a dominant hand and one-colored CT a symmetry
cognitive function (TMT-A and -B) were significantly
bicolored CT c asymmetry
better in the younger group than in the older group (Ta-
bicolored MT-1 d symmetry
ble 1).
Six out of eight e-Peg task performance scores are bicolored MT-2 e asymmetry

Table 1 Demographic data of the participants.

Older group Younger group
Participants p-Value
(n = 6) (n = 9)
**
Age (years) 80.2 ± 5.1 21.2 ± 2.2
Gender (male/female) 3/3 4/5 −
Hand laterality (R/L) 6/0 9/0 −
Grip strength (R) (kg) 26.3 ± 13.6 33.8 ± 10.3 n.s.
Pinch strength (R) (kg) 5.4 ± 3.2 4.9 ± 0.9 n.s.
*
BBT score (R) 56.7 ± 5.5 67.8 ± 11.0
**
PPT score (R) 12.3 ± 1.2 15.9 ± 2.3
**
TMT-A 53.6 ± 14.6 30.0 ± 6.4
**
TMT-B 85.7 ± 17.1 38.0 ± 10.1
MMSE 28.8 ± 1.2 − −
* **
Data are expressed as mean ± SD. Wilcoxon s rank sum test (n = 15), : p < 0.05, : p < 0.01, n.s.: not significant. BBT: Box
and Block Test; PPT: Purdue Pegboard Test; TMT: Trail Making Test; MMSE: Mini-Mental State Examination.
 (86) Advanced Biomedical Engineering. Vol. 12, 2023.

Table 3 Correlations between e-Peg score and dexteri-

ty/cognitive tests.
BBT PPT TMT-A TMT-B
** **
one-colored BT − 0.78 − 0.70 0.42 0.42
** ** *
bicolored BT − 0.70 − 0.81 0.56 0.60*
one-colored CT − 0.80** − 0.65** 0.48 0.43
* **
bicolored CT − 0.42 − 0.58 0.69 0.67**
bicolored MT-1 0.29 0.48 − 0.50 − 0.66*
bicolored MT-2 − 0.16 0.04 − 0.06 0.01
*
Spearman s rank correlation analysis (n = 15), : p <
0.05, **: p < 0.01.
BT: a basic task; CT: a comparison task; MT: a memo-
ry task; BBT: Box and Block Test; PPT: Purdue Peg-
board Test; TMT: Trail Making Test. The time required
was used as the score in BT and CT; the number of
correct answers was used as the score in MT.

dexterity/attention span decline due to increase in age.

Additionally, Walters et al. [22] conducted an eye track-
ing study during commonly used dexterity tests such as
NHPT and GPT, and reported a greater number of cor-
rective saccades and lesser time gazing at the pegboard
holes in older compared with young adults . Therefore,
Fig. 6 e-Peg performance. our result may reflect the age-related oculomotor charac-
Wilcoxon s rank sum test (n = 15), *: p < 0.05, **: p < teristics which are related to visual attention. In our next
0.01. The completion time was obtained from the study, we plan to investigate the relationship between
tasks performed perfectly by all participants in each eye movements and each e-Peg task performance in dif-
age group. ferent age groups.
The median number of correct answers in the bicol-
or asymmetrical MT was the lowest among all tasks in
found (Table 3). each group. Rajsic et al. [23] examined visual working
memory when 18 healthy university students and hospi-
3.4 Subjective evaluations tal staff memorized the type and number of objects, and
Sixty-seven percent of older and 100% of younger par- reported that their performance was higher for a symmet-
ticipants answered that the e-Peg system was easy-to-use rical condition than for an asymmetrical condition.
(Fig. 7a). The system was also judged to be interesting Asymmetrical tasks would require more attention/mem-
by 67% (older) and 78% (younger) of participants for ory during color and location memorization than other
BT, by 50% (older) and 78% (younger) for CT, and by tasks.
83% (older) and 100% (younger) for MT (Fig. 7b). The
task level was judged to be easy for BT/CT by 67% (old- 4.2 Relationship between e-Peg score and functional
er) and 100% (younger), and difficult for MT by 67% assessments
(older) and 56% (younger) of participants (Fig. 7c). There were significant negative correlations between
one-color BT/CT and dexterity tests, and bicolor BT/CT
4. Discussion
had significant correlations with dexterity tests and TMT.
4.1 Comparison of e-Peg performance by age group The TMT subjects examinees to a cognitive load via task
The e-Peg scores in the older group were significantly transition and attention switching [13]. Grubert et al. [24]
lower than those in the younger group in five out of six reported that the element of attention required was qual-
tasks. As previous studies described decreases in hand/ itatively different during a one- and a two-color number
finger muscle strength, manipulation, walking ability, searching task. These results suggest that the bicolor
and information processing speed with age [19–21], the tasks reflected an examinee s hand manipulation and
age difference in e-Peg scores could have been caused by switching attention.
 Sayaka OKAHASHI, et al: e-Peg Development for Dexterity/Cognitive Rehabilitation (87)

gests that the MT reflects an examinee s visual working

memory and executive function when memorizing the
two-color pattern and placing each colored peg in its ap-
propriate position.

4.3 Usability, interest, and difficulty

The e-Peg system was judged to be easy-to-use by the
majority of participants. One reason would be that our
peg size, which was approximately 15 mm in diameter,
was designed with reference to daily necessaries such as
chopsticks and personal seals. The system was judged to
be interesting by 50–78% of participants for BT/CT and
by more than 80% for MT. The task level was judged to
be easy by 67–100% of participants for BT/CT, and dif-
ficult by more than 50% of participants for MT. Csiksz-
entmihalyi [25] reported that people found it interesting
when a challenge level was neither too high nor too low
for their current ability. Not all participants performed
the bicolor MT correctly, which suggests that the diffi-
culty level was appropriate for them.

4.4 Comparison between e-Peg and other analog/

digital pegboards
There are three advantages of using e-Peg. First, the sys-
tem can assess not only a motor task, but also a mo-
tor-cognitive dual-task as an all-in-one test. Some similar
digital pegboards with precise automated time calcula-
tion [17, 18] aimed only at assessing dexterity based on
the conventional pegboards. Petrigna et al. [26] have re-
ported that the 25-hole GPT, which involves placement
of keyhole-shaped pegs, performed in a dual-task situa-
tion is a feasible test to evaluate manual dexterity. A du-
al-task cognitive condition is a more challenging situa-
tion compared to that of motor condition or single task
alone.
Second, our e-Peg system is superior to other com-
mercial products such as Rapael Smart PegboardTM
(Neofect USA Inc.) [27] due to automatic correct/incor-
rect judgement of two-color peg insertion in each hole
using magnetism and diversity of the hole lighting pre-
sentation according to configurable color patterns via an
SD card.
Third, the e-Peg has better size and weight compared
to other products (Table 4). The compactness is a merit
of being usable at home or while traveling.

4.5 Limitations and future directions

Fig. 7 Subjective evaluations of e-Peg tasks.
These encouraging results were obtained only from our
Older adults (n = 6), younger adults (n = 9). preliminary study, and need to be verified with a large
number of participants including different age groups
and medical conditions, referring to a study on reliability
There was a significant negative correlation between of PPT in adults after stroke [28].
a bicolor symmetrical MT and TMT-B. The result sug- Patients usually struggle to maintain a high level of
 (88) Advanced Biomedical Engineering. Vol. 12, 2023.

Table 4 Comparison table of size and weight.

Funding
Rapael Smart
e-Peg PPT BBT This work was supported by the Office of Society-Aca-
PegboardTM
demia Collaboration for Innovation, Kyoto University
height 50 20 170 32
under the 8th Incubation Program and the FY2018 GAP
size (mm) width 180 300 290 557
Fund Program, and KAKENHI; Grant-in-Aid for Scien-
depth 200 450 290 353 tific Research (C) (21K00229).
approximate weight
0.65 1.0 5.0 6.3 Data Availability
(kg)
The data that support the findings of this study are avail-
able from the corresponding author upon reasonable re-
motivation for rehabilitation over a 2-month lengthy hos- quest.
pital stay. Popovic et al. [29] reported that feedback-me-
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Innov. 5(1), 2, 2022.
Medicine. He is a Research Fellow in the Depart-
19. Torrens-Burton A, Basoudan N, Bayer AJ, Tales A: Perception
ment of Rehabilitation Medicine at Kansai Medi-
and reality of cognitive function: Information processing speed,
perceived memory function, and perceived task difficulty in older cal University. He is an Occupational Therapist
adults. J Alzheimers Dis. 60(4), 1601–1609, 2017. and received his Master s degree from Kyoto Uni-
20. Ranganathan VK, Siemionow V, Sahgal V, Yue GH: Effects of versity. His research interests include development cognitive rehabili-
aging on hand function. J Am Geriatr Soc. 49(11), 1478–1484, tation system using Cross Reality (xR) technology.
2001.
21. Abe T, Soma Y, Kitano N, Jindo T, Sato A, Tsunoda K, Tsuji T, Fumitaka HASHIYA
Okura T: Change in hand dexterity and habitual gait speed re- Fumitaka HASHIYA is assistant professor of Re-
flects cognitive decline over time in healthy older adults: a longi- search Center for Material Science at Nagoya Uni-
tudinal study. J Phys Ther Sci. 29(10), 1737–1741, 2017. versity. He majored in chemical biology and re-
22. Walters BH, Huddleston WE, O Connor K, Wang J, Hoeger Be- ceived MS and PhD from Kyoto University in
ment M, Keenan KG: The role of eye movements, attention, and 2019. His current research is RNA therapeutics
hand movements on age-related differences in pegboard tests. J including mRNA vaccine and siRNA therapy.
Neurophysiol. 126(5), 1710–1722, 2021.
23. Rajsic J, Wilson DE: Asymmetrical access to color and location
Keisuke KUMASAKA
in visual working memory. Atten Percept Psychophys. 76(7),
Keisuke KUMASAKA is currently an Occupational
1902–1913. 2014.
Therapist in Asaka Hospital after working at Kyoto
24. Grubert A, Eimer M: Qualitative differences in the guidance of
Ohara Memorial Hospital group. He received his
attention during single-color and multiple-color visual search:
behavioral and electrophysiological evidence. J Exp Psychol degree of Bachelor from the Department of Human
Hum Percept Perform. 39(5), 1433–1442, 2013. Health Sciences, School of Medicine, Kyoto Uni-
25. Csikszentmihalyi M: Beyond Boredom and Anxiety. Jossey- versity in 2016. His special fields are stroke/disuse
Bass, Hoboken, NJ, 2000. syndrome rehabilitation and mental health support.
26. Petrigna L, Pajaujiene S, Iacona GM, Thomas E, Paoli A, Bianco
A, Palma A: The execution of the grooved pegboard test in a du- Taro YAMAGUCHI
al-task situation: a pilot study. Heliyon. 6(8), e04678, 2020. Taro YAMAGUCHI is a lecturer, Kyoto University
27. Neofect: Smart Pegboard <https://www.neofect.com/us/smart- Medical Science and Business Liaison Organiza-
pegboard> [accessed on October 8, 2022]. tion after Sharp Corporation. He has engaged in
28. ClinicalTrials.gov: Establishing of the Reliability of the Purdue supporting the creation and growth of startups. He
Pegboard Test in Adults After a Stroke. <https://clinicaltrials. also serves at a Kyoto University startup company.
gov/ct2/show/NCT05009108> [accessed on October 8, 2022]. He has Bachelor and Master of Engineering (Osa-
29. Popovic MD, Kostic MD, Rodic SZ, Konstantinovic LM: Feed- ka University), Master of Business Administration (Kobe University),
back-mediated upper extremities exercise: increasing patient mo- and Master of Social Public Health (Kyoto University).
tivation in poststroke rehabilitation. Biomed Res Int. 2014,
520374, 2014.
30. Gamboa E, Ruiz C, Trujillo M: Improving patient motivation to-
wards physical rehabilitation treatments with PlayTherapy Exer-
game. Stud Health Technol Inform. 249, 140–147, 2018.
 (90) Advanced Biomedical Engineering. Vol. 12, 2023.

Akitoshi SEIYAMA
Akitoshi SEIYAMA received the doctor degree of
Science from the Graduate School of Science,
Hokkaido University in 1988. He was Professor of
Kyoto University, Graduate School of Medicine,
Human Health Sciences. Since April/2022, he is a
select Professor of Akita International University,
a director of Creative Design and Data Science Center. He is develop-
ing new technologies to visualize physical and physiological functions
of the living body, especially to visualize human brain functions.

Jun UTSUMI
Jun UTSUMI is CEO of TIR Research Consulting
LLC on R&D for practical application of pharma-
ceuticals and medical devices. He obtained PhD
from Hokkaido University and MBA from Otaru
University of Commerce. After starting business
carrier in pharmaceutical research and clinical de-
velopment at Toray Industries, Inc., he had appointments of professor
of Hokkaido University and Kyoto University. He also served consult-
ing experts in Pharmaceuticals and Medical Devices Agency (PMDA)
and Japan Agency for Medical Research and Development (AMED),
Japan.